Chronic Back Pain And Fibromyalgia

Chronic back pain, which includes pain at the base of the neck and the skull, is particularly devastating for people with fibromyalgia. Back and neck pain is often one of the first symptoms noted, especially when the triggering factor for the development of fibromyalgia is trauma or injury to the back and neck. Since all movement of the body impacts the spinal column, this type of chronic pain greatly impacts even the smallest of daily tasks and activities.

Chronic back and neck pain is also seen as a major factor in the risk of developing depression, a condition often associated with any type of chronic pain syndrome or condition. The additional complication is that the back pain associated with fibromyalgia does not respond to traditional types of medications that help to alleviate the symptoms of pain. Anti-inflammatories, even prescription medications, have little effect since the pain is not an inflammation related condition. In research with fibromyalgia patients with back pain compared to patients with back pain without fibromyalgia, some interesting hormonal differences were noted that explains this lack of response to traditional medications used for the control of back pain.

Researchers found that individuals that experienced both lower back pain and had a diagnosis of fibromyalgia had a dysregulation of the HPA axis, specifically low levels of cortisol levels produced as well as a hyperactivity of the pituitary to the presence of the corticotrophin-releasing hormone, creating overall higher levels of ACTH. Patients with lower back pain only without fibromyalgia had some tendency to this same pattern of HPA axis change, but containment of stress response was higher. 1

Other research has focused in on the role of musculoskeletal pain and fatigue in the role of diagnosis of fibromyalgia. This research compared patients with diagnosed fibromyalgia, patients with depressive disorders and patients with chronic back pain to determine if different types of pain were experienced. In the research, which was a scaled type survey, patients with fibromyalgia had more limb pain and fatigue than other patients, including those with chronic back pain but not fibromyalgia. 2 From this study, they concluded that the pain response difference in patients with fibromyalgia could be used a diagnostic tool since the pain was chronic and widespread as opposed to localized.

The Experience 

Chronic back pain and chronic neck pain in fibromyalgia patients is different than that of patients with back pain but without fibromyalgia. The biggest difference is that the back and neck pain with fibromyalgia is ongoing and doesn’t become better or less intense with time and medications. In many cases, deep muscle massage may help, however it is also incredibly painful to experience if hypersensitive and tender points are present. In addition to touch, stretching exercises, particularly early in the day when the body is stiff, tend to be very difficult and incredibly painful, but often proves helpful in the treatment of the pain.

Often people with fibromyalgia that have chronic back and neck pain have difficulty being recognized as experiencing such pain. They may be seen as chronic complainers or people trying to get out of work or daily activities. In reality, every type of movement and pressure along the neck or spine produces pain. This means that even the “easy” jobs that require sitting or standing in one place can be highly problematic. Driving may be impossible due to the constant movement of the shoulders and the pressure on the lower back when moving the legs.

In addition to the incredible pain with movement and the increased sensitivity of the tender points, often located on the shoulders, neck, spine and buttocks, patients with fibromyalgia also face higher average cost of care.

In a study in Europe individuals with fibromyalgia, chronic lower back pain and ankylosing spondylitis (an inflammation of the joints between the spinal bones and the spine and the pelvis), were compared by having patients keep a cost journal. The patients with the chronic lower back pain and fibromyalgia had the highest costs of annual care, €7813 for fibromyalgia and €8533 for chronic lower back pain. These high costs over the duration of the year were partly due to the need for formal and informal medical treatment as well as work days lost. 3

Non-Medical Treatment Options

One of the best options in alleviating the pain of fibromyalgia, particularly in the back and neck, is the use of gentle and sustained heat. This can include using a heating pad, heat wraps or soaking in a warm bath or hot tub. This can be done at home or in a spa and may be combined with gentle massage after warming to help stretch muscles without causing additional pain.

In a study of women with fibromyalgia that exercised in warm water, a general decrease in pain, increase in mobility and increase in quality of life was noted. This study lasted eight months and included 33 women, all who reported improvements in desired outcomes and decreases in the negative symptoms of fibromyalgia.

A similar study that included 60 middle-aged women with fibromyalgia compared aquatic training in warm water doing traditional types of exercise to a control group that did not participate in any supervised type of exercise. The results, after 16 weeks, showed that women with fibromyalgia that exercised in the warm water pool had lower self-reported pain, higher pain thresholds, lower tender point counts and less severity of their fibromyalgia overall. In addition, comparing a baseline and follow-up test showed there was improved cognitive functioning. 5

Other non-medical treatment options include the use of back supports that can be effective in providing support for back muscles that are weakened from inactivity or stress.  Other alternative treatments can include acupuncture, massage therapy and chiropractic treatments, but it is essential to work with a professional that is experienced in assisting patients with fibromyalgia.

References

1 Boersma, J., Griep, E., Lentjes, E., et al. (1998). Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain. Journal of Rheymatology , 1374-1381

2 Hauser, W., Grulke, N., Michalski, D., et al. (2009). Intensity of limb pain and fatigue in fibromyalgia syndrome, depressive disorders and chronic back pain. A criterion for differentiation. Schmerz , 267-274.

3 Boonen, A., van den Heuvel, R., van Tubergen, A., et al. (2005). Large differences in cost of illness and wellbeing between patients with fibromyalgia, chronic low back pain, or ankylosing spondylitis. Annals of the Rheumatic Diseases , 396-402.

4Tomas-Carus, P., Gusi, N., Hakkinen, A., et al (2008). Eight Months of Physical Training in Warm Water Improves Physical and Mental Health in Women with Fibromyalgia: A Randomized Controlled Trial. Journal Of Rehabilitative Medicine , 248-252.

5 Munguia-Izquierdo, D., & Legaz-Arrese, A. (2007). Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia. Clinical and Experimental Rheumatology , 823-830.

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015